Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following (...), 2023, Achleitner et al

[Wyva]

Full title:
Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis

Abstract

In the aftermath of the COVID-19 pandemic, we are witnessing an unprecedented wave of post-infectious complications. Most prominently, millions of patients with Long-Covid complain about chronic fatigue and severe post-exertional malaise. Therapeutic apheresis has been suggested as an efficient treatment option for alleviating and mitigating symptoms in this desperate group of patients. However, little is known about the mechanisms and biomarkers correlating with treatment outcomes.

Here, we have analyzed in different cohorts of Long-Covid patients specific biomarkers before and after therapeutic apheresis. In patients that reported a significant improvement following two cycles of therapeutic apheresis, there was a significant reduction in neurotransmitter autoantibodies, lipids, and inflammatory markers. Furthermore, we observed a 70% reduction in fibrinogen, and following apheresis, erythrocyte rouleaux formation and fibrin fibers largely disappeared as demonstrated by dark field microscopy.

This is the first study demonstrating a pattern of specific biomarkers with clinical symptoms in this patient group. It may therefore form the basis for a more objective monitoring and a clinical score for the treatment of Long-Covid and other postinfectious syndromes.

Open access: https://www.nature.com/articles/s41380-023-02084-1

 

[Hutan]

Randomized controlled trials using an invasive procedure requiring sham treatments are ethically challenging and time-consuming due to regulatory issues. This underlines the need for approving practice-oriented medical approaches instead of insisting on evidence-based medicine in such times of immediate need.

How long does "immediate need" work as an excuse for not producing robust evidence? A year? two years? five years?

In Cham and Baden-Baden in Germany and at the Alpstein Clinic in Gais in Switzerland, a cohort of 27 patients with Long-Covid was treated with therapeutic apheresis and chronic fatigue syndrome and post-exertional malaise were evaluated by standard questionnaires for Long-Covid before and after apheresis. Informed consent was obtained from all study subjects.

in 27 patients who showed clinical improvement after extracorporeal therapeutic apheresis and found that the biomarkers were significantly reduced after the treatment.

Some of the results they report of 'before' and 'after' do look interesting. But the paper is inconsistent in explaining that these 27 patients were selected specifically because they reported feeling much better after the treatment. They don't tell us how many people in total were treated in the sample that these patients were taken from.

There's also clearly not a state of equipoise in the researchers; there's a major conflict of interest.

In conclusion, this study clearly shows that extracorporeal apheresis is a powerful technology to reduce biomarkers that have been implicated in the pathogenesis of post-infectious syndromes such as Long-Covid. This, however, describes only an association and not causality and a clear correlation with symptoms and improvement of patients.

It really doesn't. We don't know if the aphaeresis did something, or the heparin that was administered at the same time, or if this cherry-picked sample just got better over time. We don't know if some of the things that were filtered out (and therefore unsurprisingly showed decreases after treatment) have any relationship to symptoms.

 

[dave30th]

This is a Nature journal. It sure is strange that they allow a declarative statement of causality in a study of 27 people with no comparisons n group.